Provider Demographics
NPI:1477695930
Name:AHMAD, SYED N (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:N
Last Name:AHMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N
Other - Middle Name:SYED
Other - Last Name:AHMAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:56 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8327
Mailing Address - Country:US
Mailing Address - Phone:631-665-2288
Mailing Address - Fax:631-665-2288
Practice Address - Street 1:56 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8327
Practice Address - Country:US
Practice Address - Phone:631-665-2288
Practice Address - Fax:631-665-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1462242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669154Medicaid
NY00669154Medicaid